1
Adapting ITIL for Effective Telehealth Service
Management
Session 141, Wednesday, February 13, 2019
Shawn Valenta, Administrator of Telehealth, MUSC Health
Dr. Jillian Harvey, Associate Professor, Medical University of South Carolina
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Shawn Valenta, RRT, MHA –
Has no real or apparent conflicts of interest to report.
Jillian Harvey, Ph.D –
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Agenda
• Telehealth Background
• Complexities of telehealth service
development, implementation, and
sustainability
• Ideas for telehealth best practices:
The structured framework
4
Learning Objectives
• Recognize the complex factors that challenge effective
telehealth service development, implementation and
sustainability
• Describe the five phases of MUSC’s telehealth service
management framework
• Identify key elements that contribute to a successful,
sustainable telehealth service
• Explain how the RACI Matrix is applied to telehealth
service management
Brief History of Telehealth
Virtual Health: Aligning Solutions With Enterprise-Wide
Priorities. SG2 Intelligence 2014.
6
Background
• Obtaining timely healthcare services can be extremely challenging
for patients who reside in rural or medically underserved
communities.
1-2
• Telehealth appeal
• Improve access
• Improve quality
• Reduce cost
7
• Yet, telemedicine programs not widespread
3-5
• Small scale services poorly integrated into health
systems
3, 6
• Large-scale IT projects have failure rates >30%
7
• 75% of successful telehealth pilots not
sustained
8-9
Concerns
8
Telehealth Implementation
Challenges
Resource
Intensive
Assessment &
Evaluation
Insufficient
Planning & Best
Practices
Increasing
Demand
4, 7, 10, 15
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“Organizationally, telemedicine provides challenges to the
traditional notions of regionalized health care systems”
(Bashshur, 2007)
• Persistent problems have not been successfully
addressed:
4, 16
– Relationships between traditionally competing delivery
systems
• culture, practices, business models, governance
– Telehealth organizational structure
– Operational system
– Boundaries of planning regions
Telehealth Complexity
10
Telehealth Evidence Base
Strength of Evidence
Program Strategy &
Implementation
Outcomes for
Certain Specialties
Delivery & Payment
Models
Cost Effectiveness
Policy
Home Monitoring
Psychotherapy
Support
Access
Patient Satisfaction
Provider Technical
Satisfaction
11-14
Strength of Evidence
Improved
Efficiency
Process
Measures
Travel Costs
Wait Times
Transportation
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Current telehealth literature includes
multiple & separate frameworks related to:
4, 9
Readiness
Assessment
Implementation
Diffusion
Evaluation
12
Factors that Impact Telehealth Success
(Liezl van Dyk, 2014)
• Technology
• Organizational Structures
• Change Management
• Economic feasibility
• Societal impacts
• Perceptions
• User-friendliness
• Evaluation and
Evidence
• Legislation
• Policy and governance
“A holistic implementation approach is needed”
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Analysis:
1. “Strategy…not clearly articulated”; priorities and scope not maintained
2. Services created from different practice areas resulted in variation,
creating further challenges in providing operational support across the
enterprise
3. Numerous stakeholders and competing priorities negatively impacted
service development
4. Fragmented technology; no clear operational procedures
Sustainable Telemedicine: Designing and
Building Infrastructure to Support a
Comprehensive Telemedicine Practice
(Mayo Clinic Experience)
Beth L.H. Kreofsky, R. Nicole Blegen, Troy G. Lokken, Susan M. Kapraun, Matthew
S. Bushman, and Bart M. Demaerschalk.Telemedicine and e-Health.Dec
2018.ahead of printhttp://doi.org/10.1089/tmj.2017.0291
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• 13+ years of telehealth
experience
• > 70 unique telehealth services
• A HRSA-designated National
Telehealth Center of
Excellence
• Coordinating entity of the
South Carolina Telehealth
Alliance (SCTA)
MUSC Center for Telehealth
Executive Medical Director: Dr. Jimmy McElligott
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Over 200 Connected Sites
(>90% are non-MUSC)
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Volume of MUSC Telehealth
Interactions
0
50000
100000
150000
200000
250000
300000
350000
2014 2015 2016 2017 2018
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2005
Maternal Fetal
Telemedicine
2008
Telestroke
2009
ICU
Telepsych
2013
State
telehealth
funding
infused by SC
Legislature
2014-Present
MUSC Center for
Telehealth
charged with
accelerated
growth of
telehealth services
Evolution of MUSC’s Telehealth
Services
• Created a lot of pieces to service
development (e.g. checklists)
• Experienced many growing pains
• “Concentration risk”
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Initial MUSC Telehealth Goal
“Everything we do within our walls, we should do outside our walls”
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Case Study 1: Inpatient Pediatric GI
• Single provider
• ‘Customized’ workflow
– Not consistent across comparable
services
– Not mapped out
– Confusion re: roles/responsibilities
• Poor communication with partner
sites
• Inadequate training at partner sites
• No formalized evaluation plan
Low utilization
Low satisfaction
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Case Study 2: Outpatient
Transplant Nephrology
• Lack of provider champion engagement
• Workflow
– Everything to everybody = multiple changes to
workflow
– Not formally mapped out
– Confusion re: roles/responsibilities
• Service goal a moving target = delay and frustration
• No formalized governance
– Response to partner site & internal providers = multiple tech change
• High provider/staff turnover
• No pro forma & unrealistic volume expectations
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Processes to be Navigated in
Telehealth Service Development
Strategy
Procurement
Compliance
Legal
Provider
engagement
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- Created by UK in 1980’s
- Detailed practices for IT
service management
- Aligns services with business
needs
- Used worldwide:
- US Governments (States,
Navy, Army)
- Industry (Disney, Honda,
Visa)
Discovered ITIL
(Information Technology Infrastructure Library)
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“Telehealth is a clinical service delivered
over an IT service”
• Provided terminology and a standard framework
• Highlighted strengths & weaknesses
Adapted the Idea of ITIL to
Create the Telehealth Service
Implementation Model
(T-SIM
©
)
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Telehealth Service
Implementation Model (T-SIM
©
)
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Telehealth Service Strategy
• Defines scope of the service
• Condition(s)
• Location of patients
• Type of providers
• What problem is being
solved?
Key Processes:
• Strategy Management
• Demand Management
• Portfolio Management
• Financial Services Management
• Business Relationship Management
(BRM)
• Value Creation
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Thinking beyond “replicating care over distance”
MUSC Mission statement: “Telehealth for efficient,
effective care”
Assess the impact on stakeholders:
1) Patients
2) Referring providers
3) Consulting providers
4) Payers
5) Health system (as a whole)
Prioritize services that:
• Add efficiency to care teams
• Add value to care over the continuum
• Mitigate time and distance barriers to care
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Telehealth Standardized Scoring Tool
Support of implementation
• Physician champion
• Provider capacity
• Strategic alignment
Potential impact
• Quality
• Cost
• Access to care
Growth opportunity
• Market size
• Saturation
• Demand
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Telehealth Cardinal Sins
Setting up a telehealth program:
1. without provider engagement &
availability
2. without a clear path from patient to
technology
3. without an evaluation plan
4. untethered from organizational strategy
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Telehealth Service Design
• Implement a common
architecture
• Understand each “site of care”
has different rules
• Draft clinical and operational
protocols
• Customize test scripts
• Identify KPI’s
• Navigate compliance, legal,
credentialing and EHR issues
and processes
Key Processes:
• Design Coordination
• Availability Management
• Capacity Management
• Information Security
Management
• Training Management (internal
staff, providers, sites)
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Design Coordination
– maintain a common architecture for all activities and processes
Clinical
Protocols Workflows Test Scripts
Technology
Equipment
and Site
Assessment
Procurement Installation
Administrative
Legal
Credentialing
- Regulatory
Billing -
Compliance
Outcomes
Performance
Metrics
KPI Tracking
Outcomes
Reporting
Strategy
Define scope of the service
• Condition(s)
• Location of patients
• Type of providers
• What problem is being
solved?
Transition
Training
• Equipment
• Workflow
Mock
Calls
• Technology Pre-
check
• Dedicated Support
Go-Live
• Dedicated IT and
Operational Support
Design
Meet the
needs of the
customers!
Operations
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RACI matrix…
through the common architecture
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Telehealth Service Transition
Design
Operations
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Telehealth Service Transition
Movement from test to
go-live
• Training – tech and workflow
• Mock calls (alpha – internal
testing, beta – partner site
testing)
Key Processes:
• Transition Planning &
Support
• Data & Knowledge
Management
• Change Management
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Telehealth Service Operations
• High quality, reliable services
• Processes to manage
“incidents”
• any unplanned event that has a
negative impact on normal
operations
Key Processes:
• Incident Management
• Problem Management
• Access Management
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• Striving for high-reliability
• Preoccupation with failure
• Reluctance to simplify interpretations
• Sensitivity to operations
• Commitment to resilience
• Deference to expertise
Continual Quality Improvement
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Summation
• Telehealth journey is complex
• Success is achievable
• Structured implementation
framework is major catalyst
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10. Yellowlee
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References
